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Undiagnosed endometrial abnormalities in women with normal hysterosalpingography scheduled for IVF: prospective evaluation of three-dimensional transvaginal ultrasound versus office hysteroscopy
Get PDFObjectives: To compare the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D-US) to office hysteroscopy (OH) in the screening of uterine cavity with normal hysterosalpingography (HSG) findings for subtle endometrial abnormalities before in vitro-fertilization (IVF).
Methods: A prospective cohort cost-modeling study was carried out in a University hospital. We included 120 infertile women with a normal uterine cavity on HSG scheduled for IVF. All cases were evaluated by 3D-US, and the results were compared with OH findings.
Results: OH revealed cavitary endometrial lesions (CLs) in thirty-four women (28.3%). Endometrial polyps were the most common detected lesions (16, 47.1%). 3D-US had 88.2% sensitivity, 96.5% specificity, 90.9% positive predictive value, 95.4% negative predictive value, and 94.2% overall accuracy for CLs. The overall agreement between 3D-US and OH was near-perfect (κ=0.86, 95% CI=0.75-0.96). Irregular menstrual bleeds and prior endometrial procedures were significant predictors for CLs (aOR=24.96, 95% CI=2.71–230.04, P=0.005, aOR=9.16, 95% CI=2.13–39.3, P=0.002, respectively). A selective screening strategy discerning OH to women with these predictors and/or women with abnormal 2D-US would have an NPV of 92.8 % with substantial cost benefits.
Conclusions: In the pre-IVF work up, 3D-US, a non-invasive imaging modality, seems to be nearly comparable to OH. Office hysteroscopy screening prioritizing women with abnormal 2D-US, irregular menstrual periods and/or prior endometrial traumatization could yield a satisfactory cost-effective approach for identifying endometrial lesions
Rachel A. Maassen, MD, MBA
Get PDFRachel A. Maassen, MD, MBA
Clinical Associate Professor of Obstetrics and Gynecology - General Obstetrics and Gynecology.
Medical Director for Clinical Risk Management for Carver College of Medicine, the University of Iowa Physicians Group, and University of Iowa Hospitals and Clinics Director, Division of General Obstetrics and Gynecology
The Mound Builder Myth: Fake History and the Hunt for a \u27Lost White Race\u27
No full textReview of: The Mound Builder Myth: Fake History and the Hunt for a \u27Lost White Race\u27, by Jason Colavit
The Merchant Prince of Black Chicago: Anthony Overton and the Building of a Financial Empire
No full textReview of: The Merchant Prince of Black Chicago: Anthony Overton and the Building of a Financial Empire, by Robert E. Weems, Jr
Bedrock Geologic Map of the Donnellson 7.5\u27 Quadrangle, Lee County, Iowa
Get PDFhttps://ir.uiowa.edu/igs_ofm/1162/thumbnail.jp
Everything Old is New Again: How the Vaping Industry Borrowed Banned Practices of the Tobacco Industry
Get PDFThe key objective of this research is to determine if health regulators can prohibit marketing products to children based on likely health outcomes without specifying the exact product (i.e., e-cigarettes) and business activity (i.e., advertising). My thesis illustrates how the vaping industry took a tobacco-derived product, e-cigarettes, and employed the same banned marketing activities that helped create the traditional cigarette industry to harm today’s consumers. My analysis directly compares banned marketing practices for cigarettes with ecigarettes regarding advertising, packaging, flavorings, endorsements, marketing campaigns, and targeting of the vulnerable youth population. The thesis will conclude by providing recommendations based on this analysis of how product regulations should be crafted to increase the effectiveness of new regulations to curtail their introduction and dangerous marketing rather than the current post hoc practice of writing regulations to minimize the harm caused by products already on the market
Mixed Media Stone Setting with Paint and Fabric
Get PDFStone setting is a jewellry technique that emerged contemporaneously with casting and other heat-based technologies, resulting in a long held relationship to heated processes in the formation of the metal armature for the stone. As the 2020 COVID-19 shutdown caused me to set aside my previous research on enamel painting and work within the constraints of having no access to a metal shop, I decided to explore a prior interest in stone setting through non-heat based mixed media.
My aim was to find a way to house stones in a secure alternative medium without requiring a torch or the metal shop environment. While it is possible to set stones within a small studio, the safety requirements for my apartment sent me in an exploratory direction. Lack of extensive ventilation or space to work outside determined that wood, cement, resin, silicon, and plastic were not viable options for me to complete the stone setting. During preliminary designs, I found the bezel wire on hand was too short and could not form an effective setting without solder. Through a series of tests on materials in my flat, I discovered that acrylic hard body paint was strong enough to encase stones without losing them within the paint itself. I experimented with a series of setting designs, and attempted to address several concerns. The first question was how deep did the stone need to be set into the paint. On one attempt the stone was secured quite firmly into the paint, however, this obscured the stone and it lost the sense of a setting. In my second attempt, I wrapped copper wire in a tab setting around a fragment of layered powder coat, embedding the wire and piece within a thick layer of acrylic paint. This resulted in a successful attachment, but the weight difference between stones and the powder coat was significant. The wire proved un-necessary, both structurally and design-wise. It didn’t offer additional stability, and created an uneven base. The final tests involved directly setting stones into paint on both a silicon mat and fabric. They could then be peeled off or left with the stone in-situ. I poured the acrylic colours directly, evening out and marbling the paint with a scrapper. A subsequent concern was how to control the flow of the paint. During the drying stage, the acrylic paint could be molded into a shape, but the tests left to dry undisturbed fared better in the long run. While possible to trim the edges of the paint panels after the drying process, I preferred the fluid forms created by the palate knife. I shaped copper strips to form a barrier that could be set down into the paint and removed in order to form a bezel appearance. To facilitate the connection to other fabric, I set mesh strips under the paint for better adherence and experimented with sewing them to the backing fabric both before and after paint application. After creating the paint-bezel, I applied additional layers of paint directly to the mesh. Multiple paint-bezelled stones were then placed into the paint and left to dry.
Though the situation was born out of necessity, I found that incorporating a fluid medium into stone setting offered me a spontaneity not usually found in traditional settings. The natural flexibility of the acrylic paint suited pieces relying on underlying structures, yet could also be adapted to create three-dimensionality. Utilizing the paint-bezel style allowed me to extend the setting process beyond small stones and incorporate an enameled piece in my final designs. I found the process quite satisfying and would like to continue to explore its application with both my enameled works and stones on a larger scale
Placental pouch closure: a novel, safe and effective surgical procedure for conservative management of placenta accreta
Get PDFBackground: Placenta accreta spectrum (PAS) has become a global problem secondary to the high rate of cesarean delivery (CD). The current study presents an effective surgical procedure (placental pouch closure) for uterine preservation in patients with PAS.
Methods: We applied this procedure in sixty cases at a tertiary university hospital between September 2017 and January 2019. We included women who were diagnosed as PAS based on preoperative ultrasound and Doppler evaluation, and who had the desire for uterine preservation.
Results: The procedure was successful in almost all cases; the uterus was conserved 98.33 % of participants, with no associated severe maternal morbidities or mortality. In all cases, no additional surgical procedures were needed. The mean blood loss was 1263 ml, and the mean number of units of blood required for transfusion was 2.31 units.
Conclusion: Identifying and meticulously closing the placental pouch is a novel surgical procedure for conservative management of PAS. In well-selected cases with the availability of facilities and expertise, the technique could have a place as a safe and effective surgical technique in women presenting with placenta accreta who desire uterine preservation.
Trial registration number: NCT03241849. Registered on August 8, 201